Supporting the health and development of rural Montanan infants and toddlers via family-centered
early intervention

Kalli Decker: Montana State University

Abstract

This pilot research project will investigate the delivery of early intervention services
in rural Montana and identify professionals’ strengths and areas for improvement,
as well as possible barriers to providing services aligned with research-based recommended
practices. These quantitative and qualitative data will be used to meet the project’s
immediate goal of providing feedback to professionals in Montana about the delivery
of early intervention services, as well as to identify ways to support these professionals
to provide family-centered early intervention. These data will also be used for this
project’s future goal, as part of a major research project: to carry out Community
Based Participatory Research to create family-centered professional development specifically
designed for the challenges faced by early intervention professionals, particularly
those who serve the most rural children and families; this professional development
would then be provided using a randomized control trial in rural areas of Montana
to determine its effectiveness. This current pilot investigation of early intervention
service delivery and identification of barriers to providing family-centered services
is the first step toward the long-term goal of supporting the health and well-being
of some of the most vulnerable individuals in Montana – infants and toddlers with
delays and disabilities living in rural areas.

Montana is listed 50th in the nation for children’s health (Annie E. Casey Foundation, 2014). For infants
and toddlers with delays and disabilities, who are in the most vulnerable period of
their development and are at risk to experience lifelong health challenges, family
involvement is a critical determinant for the impact of early intervention services
on their well-being and developmental outcomes. Therefore, there is a need for supporting
Montana’s children in the context of their families. Family-centered services are
crucial given the limited amount of time that early intervention professionals spend
with children on a monthly basis in comparison to the exorbitant amount of time these
children spend with their families; consequently, children’s health and development
can be influenced to a much greater extent if parental involvement is a targeted priority
for early intervention services. Based on families’ reports of the way in which early
intervention services are being delivered in Montana, there is reason to believe that
early intervention professionals are not providing services that are in line with
research-based recommendations, especially in the most rural areas of the state.

Specific Aims

Aim 1: Investigate the ways in which services are delivered by early intervention
therapists, and how this aligns with family-centered practices. This will be completed via videotaped observations of physical, occupational, and
speech therapists as they provide early intervention services to a child; each professional
will videotape themselves providing early intervention services with at least 3 different
children. These videos will be rated using the Home Visit Rating Scales A+ – Adapted
and Expanded (HOVRS-A+), a well-established scale used to measure the alignment of
early intervention services with family-centered recommended practices (Roggman, Cook, Innocenti, Jump Norman, Boyce, & Christiansen, in press). I hypothesize that early intervention professionals in the state of Montana are
providing services to infants and toddlers with delays and disabilities in ways that
align much more closely with a medical model than with family-centered recommended
practices.

Aim 2: Investigate therapists’ knowledge, attitudes, and experiences regarding family-centered
early intervention services, as well as their perceived barriers to providing family-centered
services. This will be completed via a semi-structured qualitative interview with each therapist.
I do not propose a specific hypothesis for this portion of the study; since this portion
of the study is exploratory and qualitative in nature, proposing specific hypotheses
could lead to interpreting the data with biases.